Strategic Plan to accelerate the development, production and distribution of LLINs

1
Strategic Plan to accelerate the development,
production and distribution of LLINs
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Rationale for LLINs (1)

• Mortality reduction estimated at 171
• Clinical episodes of P. Falciparum reduced by 48
• Abuja Targets 60 of those at risk of malaria,
  particularly children under five years of age and
  pregnant womenbenefit from protective measures
  such as insecticide treated mosquito nets
• Butnet coverage rates are low and retreatment
  rates even lower

LLINs are a solution as they do not require
retreatment during the lifespan of the net

• Lengeler C. Insecticide-treated bednets and
  curtains for preventing malaria (Cochrane
  Review). In The Cochrane Library, Issue 2 2003.
  Oxford Update Software

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Rationale for LLINs (2)
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Layout of Strategic Plan

• Market Analysis
• Understand demand and distribution of nets
• Roles of governments, institutions, and NGOs
• Assess capacity to pay for LLINs
• Producer Analysis
• Review status of LLIN technology development
• Identify issues relevant to producing LLINs in
  sub-Saharan Africa
• Strategy Development
• Estimate investment needs for increasing LLIN
  production
• Calculate financial impact of using LLINs instead
  of ITNs to achieve Abuja targets
• Outline distribution mechanisms
• Outline ways for stakeholders to work towards
  promoting LLINs

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Market Analysis net distribution falls short of
needs
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Net distribution will increase significantly
Notes Available data as of 2003
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How bednets get to people
Manufacturers
Ministries of Health
Procurement Agencies

• Donors
• Multi-lateral agencies
• World Bank
• WHO
• Global Fund
• UNICEF
• Bi-lateral agencies
• DFID
• KFW
• JICA
• Others

Social Marketing Orgs.
Wholesalers

• Distribution Programs
• EPI
• Health Facilities
• NGOs
• UNICEF

Retailers
Localized Retail Initiatives (subsidized, voucher)
(free)
Occasional
Bednet Users
Systematic
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How bednets are financed
Manufacturers
Ministries of Health
Procurement Agencies

• Donors
• Multi-lateral agencies
• World Bank
• WHO
• Global Fund
• UNICEF
• Bi-lateral agencies
• DFID
• KFW
• JICA
• Others

Social Marketing Orgs.
Wholesalers

• Distribution Programs
• EPI
• Health Facilities
• NGOs
• UNICEF

Retailers
Localized Retail Initiatives (subsidized, voucher)
Subsidized or free
Bednet Users
Commercial price
9
Many partners for net distribution

• 2500 smaller ITN programmes identified across
  Africa (WHO study)
• NetMark
• PSI
• UNICEF
• The Global Fund
• gt 510 million approved for malaria Rounds 1-4
• gt 210 million grants signed for malaria Rounds
  1-4

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Examples of Household Ability to Pay
Burkina Faso1
Cameroon2
5
5
Private
Private
Excluded
Social Mktg.
Social Mktg.
Excluded
100

90
40
30
20
10

• A net purchase can represent 1-2 months of
  discretionary income
• Marketing efforts will be critical to stimulating
  private purchases of nets, but raise concerns of
  equity

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Taxes Tariffs are a burden for producers and
consumers

• Tariffs and taxes on yarn, netting material, and
  insecticides have additive effect on final price
  of net
• Example of VAT at 20 adding OVER 20 to final
  price of net

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Classifying LLIN Technologies

• LLIN Technologies can be applied at different
  stages in production
• Technologies can fit with manufacturers
  capabilities

Largest Manufacturers
Medium-size Manufacturers
Small-size Manufacturers
Stenting
Knitting
Warping
Cutting Sewing
Packaging
Yarn Extrusion
Netting Material
Finished Net
Yarn
Dipping
Fiber-Based
Industrial
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WHOPES

• Tests safety, efficacy, and acceptability
• Four phases
• Lab testing
• Small-scale field testing
• Large-scale field testing
• Development of specifications for quality control
  and international trade
• Interim WHOPES recommendation possible after 2nd
  phase
• Institutional buyers may require WHOPES
  recommendation
• Not required for commercialization in private
  markets

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Diversity among organizations developing LLINs
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Upfront investment required to produce LLINs
Including supplementary costs, i.e. land,
building, training, QC facilities, total cost
USD 2-2.5 million to establish LLIN factory
Investment support may become an important
element for the rapid increase of LLIN
manufacturing capacity.
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Estimated costs of ensuring equity in net
distribution
Notes Cost of untreated net and insecticide
based on institutional procurement costs.
Delivery costs and freight/customs based on 2001
UNICEF report
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Recommendations of Strategic plan
ITN Working Group should be expanded to include
sociology, economic and finance, and textile
industry expertise, with a focus on the following
areas

• Technical
• Economic and Political
• Stimulating Production
• Information, Education and Communication
• Coordination

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All stakeholders have a role to play
Governments
Donors
Manufacturers
Institutional Buyers
WHO
The Global Fund
LLIN Developers
Field-based organizations
UNICEF
Other Partners
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Producer Analysis
Oil industry derivatives made into pellets
Pellets extruded into yarn
Warping, Knitting, and (Stenting)
Cutting, Sewing, and Packaging
A to Z (Olyset) Partnership
WHOPES
Majority of manufacturers in sub-Saharan Africa

• Taxes and Tariffs
• Quality Control
• Worker Safety and Environment

LLIN Technology
Fiber-based
Industrial
Dipping